Liver Fibrosis by Transient Elastography and Virologic Outcomes After Introduction of Tenofovir in Lamivudine-Experienced Adults With HIV and Hepatitis B Virus Coinfection in Ghana.

Abstract

BACKGROUND:

Antiretroviral treatment (ART) programs in sub-Saharan Africa have for many years included lamivudine as the sole hepatitis B virus (HBV) inhibitor. Long-term outcomes and the effects of introducing tenofovir as part of ART in these populations have not been characterized.

METHODS:

The study comprised a cross-sectional analysis of 106 human immunodeficiency virus (HIV)/HBV-coinfected subjects maintained on lamivudine, as well as a prospective analysis of 76 lamivudine-experienced subjects who introduced tenofovir. Patients underwent assessment of liver fibrosis by transient elastography (TE) and testing to characterize HIV type 1 (HIV-1) and HBV replication.

RESULTS:

After a median of 45 months of lamivudine treatment, HIV-1 RNA and HBV DNA were detectable in 35 of 106 (33.0%) and 54 of 106 (50.9%) subjects, respectively, with corresponding drug resistance rates of 17 of 106 (16.0%) and 31 of 106 (29.2%), respectively. Median TE values were 5.7 kPa (interquartile range, 4.7-7.2 kPa) and independently associated with HBV DNA load, aspartate aminotransferase levels, and platelet counts; 13 of 106 (12.3%) subjects had TE measurements >9.4 kPa. Twelve months after the first assessment, and a median of 7.8 months after introducing tenofovir, HBV DNA levels declined by a mean of 1.5 log10 IU/mL (P < .001). TE values changed by a mean of -0.2 kPa (P = .097), and declined significantly in subjects who had pretenofovir HBV DNA levels >2000 IU/mL (mean, -0.8 kPa; P = .048) or TE values >7.6 kPa (mean, -1.2 kPa; P = .021). HIV-1 RNA detection rates remained unchanged.

CONCLUSIONS:

A proportion of HIV/HBV-coinfected patients on long-term lamivudine-containing ART had poor HIV and HBV suppression, drug resistance, and TE values indicative of advanced liver fibrosis. Tenofovir improved HBV control and reduced liver stiffness in subjects with high HBV DNA load and TE values.

• Authors: Alexander J Stockdale, Richard Odame Phillips, Apostolos Beloukas, Lambert Tetteh Appiah, David Chadwick, Sanjay Bhagani, Laura Bonnett, Fred Stephen Sarfo, Geoffrey Dusheiko, Anna Maria Geretti, Hepatitis B Infection in Kumasi (HEPIK) Study Group
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 61 Issue 6 Pg. 883-91 (Sep 15 2015) ISSN: 1537-6591 [Electronic] United States
• PMID: 26021992 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected].

Chemical References

• Antiviral Agents
• Lamivudine
• Tenofovir

Topics

• Adult
• Africa South of the Sahara
• Antiviral Agents (therapeutic use)
• Coinfection (drug therapy)
• Cross-Sectional Studies
• Elasticity Imaging Techniques
• Female
• Ghana
• HIV Infections (complications)
• HIV-1 (classification, genetics, isolation & purification)
• Hepatitis B virus (genetics, isolation & purification)
• Hepatitis B, Chronic (complications, drug therapy, virology)
• Humans
• Lamivudine (therapeutic use)
• Liver Cirrhosis (diagnosis, epidemiology)
• Male
• Middle Aged
• Prospective Studies
• Tenofovir (therapeutic use)
• Treatment Outcome
• Viral Load